This 66-year-old woman was evaluated for episodes of finger posturing. About 6 months ago, while sewing a button (she is a seamstress), she noted sudden onset of left thumb adduction and index finger extension, which was painful and lasted about 5 minutes. She had since several episodes, and the frequency increased over time, no longer requiring any manual work on her part. These were happening at anytime, almost every day, and were always painful but short lasting. Intriguingly, she had an episode of upward toe curling during each of her two pregnancies, 37 and 40 years ago, which did not recur until last a week prior to this evaluation. She was known to have hypertension, diabetes mellitus type II (with neuropathy), hypothyroidism, anxiety, chronic obstructive pulmonary disease, and sleep apnea. Her neurological exam was unremarkable, except for mild decreased sensation to temperature and vibration in the distal legs.